Turning Toward Dissonance: Lessons From Art, Music, and Literature

Makowski, Suzana; Epstein, Ronald M.

doi:10.1016/j.jpainsymman.2011.06.014

Cited by 22 publications

(17 citation statements)

References 3 publications

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“…Our research suggests that this training would benefit from an additional focus on how to say it and when to say nothing in order to be in-tune with our patients. A coaching model used by musicians may prove to be an effective model for clinicians [52–54]. Understanding silences that mark patient-centered communication could be valuable in both teaching and evaluation of effective and complete communication.…”

Section: Discussionmentioning

confidence: 99%

Eloquent silences: A musical and lexical analysis of conversation between oncologists and their patients

Bartels

Rodenbach

Ciesinski

et al. 2016

Patient Education and Counseling

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Objective: Silences in doctor-patient communication can be “connectional” and communicative, in contrast to silences that indicate awkwardness or distraction. Musical and lexical analyses can identify and characterize connectional silences in consultations between oncologists and patients. Methods: Two medical students and a professor of voice screened all 1211 silences over 2 s in length from 124 oncology office visits. We developed a “strength of connection” taxonomy and examined ten connectional silences for lexical and musical features including pitch, volume, and speaker turn-taking rhythm. Results: We identified connectional silences with good reliability. Typical dialog rhythms surrounding connectional silences are characterized by relatively equal turn lengths and frequent short vocalizations. We found no pattern of volume and pitch variability around these silences. Connectional silences occurred in a wide variety of lexical contexts. Conclusion: Particular patterns of dialog rhythm mark connectional silences. Exploring structures of connectional silence extends our understanding of the audio-linguistic conditions that mark patient-clinician connection. Practice implications: Communicating with an awareness of pitch, rhythm, and silence – in addition to lexical content – can facilitate shared understanding and emotional connection.

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Section: Discussionmentioning

confidence: 99%

Eloquent silences: A musical and lexical analysis of conversation between oncologists and their patients

Bartels

Rodenbach

Ciesinski

et al. 2016

Patient Education and Counseling

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“…18,19 No longer able to see Maria's suffering as justified, clinicians may have shifted to a self-focused response based on a negative appraisal of the situation and characterized by empathic overarousal and aversion, 17 thus turning away from the patient in response to their own distress. Increasing reports of physical symptoms such as headaches, nausea, and generalized feelings of fatigue and overall depletion, particularly by nurses, may reflect autonomic arousal and give clues about the negative impact of moral distress.…”

Section: Addressing Moral Distressmentioning

confidence: 99%

“…Clinicians likely experienced dissonance between scientific evidence, assessments of prognosis, and her husband's request to continue despite the progression of Maria's disease process. 19 Second, Tom believed that the best way to support Maria's progress was by minimizing sedation, maximizing mobility, and enhancing awareness and engagement with her family. For Tom, Maria's suffering was justified as facilitating her relational capacity and recovery.…”

Section: Addressing Moral Distressmentioning

confidence: 99%

Addressing Moral Distress: Application of a Framework to Palliative Care Practice

Rushton

Kaszniak

Halifax³

2013

Journal of Palliative Medicine

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Application of the proposed framework to a clinical case provides opportunities for understanding mechanisms of response that may be amenable to intervention and for suggesting appropriate alternative strategies and practices. A full understanding of the process can help to mitigate or to avoid the progression of distress and concurrently to appraise the situation that leads to moral distress or moral outrage.

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“…In doing so, they invite patients and their family members to respond in kind, creating a space for meaning to arise from mutual attention (Chance, 1976). Although meeting in this space may invoke distress on both sides of the stethoscope-abiding conflict and loss in the face of patients' illness experiences is not an uncommon experience for physicians (Makowski & Epstein, 2012)-it can be cause for joy from which 10 deep satisfaction may arise (Ventres, 2012b). For in addition to its communicative and clinical functions, shared presence also has a moral function: to bring alive the spirit of doctoring, placing the physicianpatient relationship at the center of the healing work that is the core of medicine.…”

Section: Offers Excellent Examples On Both Accountsmentioning

confidence: 99%

Shared presence in physician-patient communication: A graphic representation.

Ventres¹,

Frankel²

2015

Families, Systems, & Health

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Shared presence is a state of being in which physicians and patients enter into a deep sense of trust, respect, and knowing that facilitates healing. Communication between physicians and patients (and, in fact, all providers and recipients of health care) is the medium through which shared presence occurs, regardless of the presenting problem, time available, location of care, or clinical history of the patient. Conceptualizing how communication leads to shared presence has been a challenging task, however. Pathways of this process have been routinely lumped together as the biopsychosocial model or patient, person, and relationship-centered care-all deceptive in their simplicity but, in fact, highly complex-or reduced to descriptive explications of one constituent element (e.g., empathy). In this article, we reconcile these pathways and elements by presenting a graphic image for clinicians and teachers in medical education. This conceptual image serves as a framework to synthesize the vast literature on physicianpatient communication. We place shared presence, the fundamental characteristic of effective clinical communication, at the center of our figure. Around this focal point, we locate four elemental factors that either contribute to or result from shared presence, including interpersonal skills, relational contexts, actions in clinical encounters, and healing outcomes. By visually presenting various known and emergent theories of physician-patient communication, outlining the flow of successful encounters between physicians and patients, and noting how such encounters can improve outcomes, physicians, other health care professionals, and medical educators can better grasp the complexity, richness, and potential for achieving shared presence with their patients.

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Turning Toward Dissonance: Lessons From Art, Music, and Literature

Cited by 22 publications

References 3 publications

Eloquent silences: A musical and lexical analysis of conversation between oncologists and their patients

Eloquent silences: A musical and lexical analysis of conversation between oncologists and their patients

Addressing Moral Distress: Application of a Framework to Palliative Care Practice

Shared presence in physician-patient communication: A graphic representation.

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